Method and apparatus for restoring articular cartilage

ABSTRACT

The present invention comprises the provision and use of new and improved arthroscopic instrumentation for (i) harvesting a tissue biopsy from a non-critical section of a joint, and (ii) sizing and seating an autologous graft at an implant site.

REFERENCE TO PENDING PRIOR PATENT APPLICATION

This patent application claims benefit of pending prior U.S. ProvisionalPatent Application Ser. No. 61/383,823, filed Sep. 17, 2010 by Thomas C.May et al. for METHOD AND APPARATUS FOR RESTORING ARTICULAR CARTILAGE(Attorney's Docket No. PROCHON-1 PROV), which patent application ishereby incorporated herein by reference.

FIELD OF THE INVENTION

This invention relates to medical apparatus and procedures in general,and more particularly to medical apparatus and procedures for restoringarticular cartilage.

BACKGROUND OF THE INVENTION

Articular cartilage is a firm, rubbery tissue that covers thearticulating surfaces of bones. Articular cartilage provides a smoothgliding surface for joints and acts as a cushion between adjacent bones.

Articular cartilage can break down due to overuse, injury and/ordisease. This deterioration of articular cartilage can result insubstantial pain and swelling for the patient, and can significantlyimpact patient lifestyle.

Various treatments have been devised to address the deterioration ofarticular cartilage. In some circumstances, a plug of bone (with asegment of articular cartilage attached thereto) may be harvested fromone part of the body and transplanted to another part of the body, e.g.,from a non-weight-bearing section of a joint to a weight-bearing sectionof a joint. In other circumstances, a prosthetic device (having a smoothbearing surface formed thereon) may be installed in place of thedeteriorated articular cartilage. However, the aforementioned plugtransplantations, and the aforementioned prosthetic deviceinstallations, tend to suffer from a number of deficiencies, e.g.,limitations on the types and sizes of cartilage defects which can betreated using these approaches, trauma to the body at the donor site inthe case of plug transplantations, performance deficiencies in the caseof prosthetic devices, etc.

Recent advances in in vitro cell growth has now made it possible torestore articular cartilage by means of autologous chondrocyteimplantation (ACI). More particularly, with this approach, a smallportion of healthy articular cartilage (sometimes referred to herein as“a tissue biopsy”, or simply “a biopsy”) is first harvested from anon-critical section of a joint (e.g., in the case of a knee or hip,from a non-weight-bearing section of the knee or hip). The harvestedtissue biopsy is then sent to a processing laboratory where it isappropriately processed, i.e., to extract healthy chondrocyte cells fromthe tissue biopsy and then culture those chondrocyte cells on a carriermatrix for a period of time (e.g., several weeks) so as to produce ahealthy, vibrant autologous graft. Thereafter, in a follow-up procedure,the implant site is prepared to receive the autologous graft, theautologous graft is properly sized for the implant site, and then theautologous graft is introduced into the body and seated at the implantsite.

Preferably the foregoing ACI procedure is conducted as an arthroscopic(i.e., as a minimally-invasive, “keyhole surgery”) procedure so as tominimize trauma to the tissue of the patient and thereby accelerate therecovery period for the patient.

While the aforementioned ACI procedure offers tremendous advantages forthe patient, it currently suffers from the lack of effectivearthroscopic instrumentation for (i) harvesting a tissue biopsy from anon-critical section of a joint, and (ii) sizing and seating anautologous graft at an implant site.

Thus there is a need for new and improved arthroscopic instrumentationfor (i) harvesting a tissue biopsy from a non-critical section of ajoint, and (ii) sizing and seating an autologous graft at an implantsite.

SUMMARY OF THE INVENTION

The present invention comprises the provision and use of new andimproved arthroscopic instrumentation for (i) harvesting a tissue biopsyfrom a non-critical section of a joint, and (ii) sizing and seating anautologous graft at an implant site.

In one preferred form of the present invention, there is provided anarthroscopic cartilage biopsy tool comprising:

an outer tube comprising a distal end, a proximal end, and a lumenextending between the distal end and the proximal end;

an inner core comprising a shaft having a distal end and a proximal end,and at least one blade mounted to the distal end of the shaft; and

the inner core being rotatably mounted within the lumen of the outertube such that the at least one blade protrudes beyond the distal end ofthe outer tube.

In another preferred form of the present invention, there is provided amethod for arthroscopically harvesting a tissue biopsy, the methodcomprising:

providing an arthroscopic cartilage biopsy tool comprising:

-   -   an outer tube comprising a distal end, a proximal end, and a        lumen extending therebetween; and    -   an inner core comprising a shaft having a distal end and a        proximal end, and at least one blade mounted to the distal end        of the shaft;    -   the inner core being rotatably mounted within the lumen of the        outer tube such that the at least one blade protrudes beyond the        distal end of the outer tube;

advancing the at least one blade of the arthroscopic cartilage biopsytool into the tissue which is to be harvested; and

rotating the inner core so as to cause the at least one blade to excisethe tissue to be harvested.

In another preferred form of the present invention, there is provided anarthroscopic suction curette biopsy tool comprising:

a hollow tube having a distal end including at least one sharp edge, aproximal end, a lumen extending between the distal end and the proximalend, and a side opening extending through the side wall of the hollowtube and communicating with the lumen.

In another preferred form of the present invention, there is provided amethod for arthroscopically harvesting a tissue biopsy, the methodcomprising:

providing an arthroscopic suction curette biopsy tool comprising:

-   -   a hollow tube having a distal end including at least one sharp        edge, a proximal end, a lumen extending between the distal end        and the proximal end, and a side opening extending through the        side wall of the hollow tube and communicating with the lumen;

applying suction to the lumen at the proximal end of the hollow tube;

manipulating the hollow tube so that the at least one sharp edge excisesthe tissue which is to be harvested; and

selectively blocking the side opening with a thumb or finger of the userso as to apply suction to the lumen at the distal end of the hollow tubeso as to secure the excised tissue to the distal end of the hollow tube.

In another preferred form of the present invention, there is provided anarthroscopic tape measurer tool comprising:

a hollow tube having a distal end, a proximal end, and a lumen extendingbetween the distal end and the proximal end;

a tape ribbon movably disposed within the lumen of the hollow tube, thetape ribbon having length markings thereon; and

movement means for moving the tape ribbon relative to the hollow tube.

In another preferred form of the present invention, there is provided amethod for arthroscopically measuring a graft site, the methodcomprising:

providing an arthroscopic tape measurer tool comprising:

-   -   a hollow tube having a distal end, a proximal end, and a lumen        extending between the distal end and the proximal end;    -   a tape ribbon movably disposed within the lumen of the hollow        tube, the tape ribbon having length markings thereon; and    -   movement means for moving the tape ribbon relative to the hollow        tube;

manipulating the movement means so that the tape ribbon is withdrawninto the interior of the hollow tube;

advancing the distal end of the hollow tube so that it resides adjacentto a graft site;

manipulating the movement means so that the tape ribbon is extended outof the distal end of the hollow tube; and

using the length markings formed on the tape ribbon to measure the graftsite.

In another preferred form of the present invention, there is provided anarthroscopic applicator tool and measuring template comprising:

an outer tube having a distal end, a proximal end, and a lumen extendingbetween the distal end and the proximal end; and

an inner rod comprising a shaft having a distal end and a proximal end,and a measuring template mounted to the distal end of the shaft;

the inner rod being movably mounted within the lumen of the outer tubesuch that the distal end of the inner rod can project out the distal endof the outer tube or be withdrawn into the lumen of the outer tube; and

the measuring template being foldable along its longitudinal axis sothat the measuring template can be received within the interior of theouter tube.

In another preferred form of the present invention, there is provided amethod for arthroscopically measuring objects and for applying anautologous graft to the anatomy of a patient, the method comprising:

providing an arthroscopic applicator tool and measuring templatecomprising:

-   -   an outer tube having a distal end, a proximal end, and a lumen        extending between the distal end and the proximal end; and    -   an inner rod comprising a shaft having a distal end and a        proximal end, and a measuring template mounted to the distal end        of the shaft;    -   the inner rod being movably mounted within the lumen of the        outer tube such that the distal end of the inner rod can project        out the distal end of the outer tube or be withdrawn into the        lumen of the outer tube; and    -   the measuring template being foldable along its longitudinal        axis so that the measuring template can be received within the        interior of the outer tube;

positioning the measuring template within the outer tube;

advancing the distal end of the outer tube to an interior site; and

advancing the measuring template out of the outer tube and using themeasuring template to measure an object at an interior site.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the preferred embodiments of the invention, which is tobe considered together with the accompanying drawings wherein likenumbers refer to like parts and further wherein:

FIG. 1 is a schematic view showing novel arthroscopic instrumentationfor harvesting a tissue biopsy from a non-critical section of a joint;

FIGS. 2-13 are schematic views showing the multi-blade cartilage biopsytool shown in FIG. 1;

FIGS. 14-18 are schematic views showing the suction curette biopsy toolshown in FIG. 1;

FIGS. 19-23 are schematic views showing a novel arthroscopic tapemeasurer tool which may be used to size an autologous graft for animplant site;

FIGS. 24-31 are schematic views showing a novel arthroscopic applicatortool and measuring template for sizing and seating an autologous graftat an implant site; and

FIGS. 32-44 are schematic views showing selected steps from an exemplaryprocedure for harvesting a tissue biopsy from a non-critical section ofa joint, and sizing and seating an autologous graft at the implant site,using the novel instrumentation of the present invention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention comprises the provision and use of new andimproved arthroscopic instrumentation for (i) harvesting a tissue biopsyfrom a non-critical section of a joint, and (ii) sizing and seating anautologous graft at an implant site.

1. Novel Arthroscopic Instrumentation for Harvesting a Tissue Biopsyfrom a Non-Critical Section of a Joint

The present invention comprises the provision and use of new andimproved arthroscopic instrumentation (“cartilage biopsy tools”) forharvesting a tissue biopsy from a non-critical section of a joint.

In one preferred form of the invention, and looking now at FIG. 1, twonovel cartilage biopsy tools are provided: a novel multi-blade cartilagebiopsy tool 100, and a novel suction curette biopsy tool 200.

(i) Multi-Blade Cartilage Biopsy Tool 100 for Harvesting a Tissue Biopsy

Multi-blade cartilage biopsy tool 100 is shown in detail in FIGS. 2-13.Multi-blade cartilage biopsy tool 100 generally comprises an outer tube105 and an inner core 110.

More particularly, outer tube 105 generally comprises a distal end 115,a proximal end 120 and a lumen 125 extending therebetween. If desired,proximal end 120 of outer tube 105 may have an enlarged diameter (e.g.,as shown at 130) relative to the remainder of the outer tube so as toprovide a more convenient handle for multi-blade cartilage biopsy tool100. In one preferred form of the invention, at least the distal end ofhollow tube 105 is transparent.

Inner core 110 generally comprises a shaft 135 having a distal end 140and a proximal end 145. A plurality of radially-extending slits 150 areformed in distal end 140 of shaft 135. Slits 150 receive blades 155 soas to mount blades 155 to the distal end 140 of shaft 135. In onepreferred form of the invention, and as shown in FIGS. 11-13, blades 155are secured to one another so as to form a single element 160, wherebyto facilitate securing blades 155 to the distal end of shaft 135 viaslits 150. In one preferred form of the invention, there are four blades155, and the blades are set at right angles to one another. Preferablyeach of the blades 155 has an angled distal end 165 in order tofacilitate biopsy harvesting when the blades are advanced into articularcartilage and rotated, as will hereinafter be discussed in furtherdetail. In this respect it should also be appreciated that the angleddistal ends 165 of blades 155 also serve to help capture tissuefragments in the hollow receiving spaces 170 formed between the bladesafter the biopsy tissue has been cut away from the donor site by theblades.

Inner core 110 is rotatably mounted within lumen 125 of outer tube 105so that blades 155 of inner core 110 protrude slightly beyond the distalend of outer tube 105, in order that blades 155 can engage and excisearticular cartilage from a biopsy site, whereby to harvest a tissuebiopsy. Preferably blades 155 protrude beyond the distal end of outertube 105 by a distance which is approximately equal to the thickness ofthe articular cartilage which is to be harvested, in order to facilitateharvesting the desired articular cartilage without also takingsignificant amounts of the underlying host bone.

In use, multi-blade cartilage biopsy tool 100 is arthroscopicallyadvanced to a donor site at a non-critical section of a joint so thatthe distal end of the multi-blade cartilage biopsy tool is adjacent tothe donor site. Then multi-blade cartilage biopsy tool 100 is advanceddistally so that blades 155 penetrate the articular cartilage. Suchdistal advancement continues until the distal end of outer tube 105engages the outer surface of the articular cartilage, whereupon distalmovement is stopped. At this point the distal ends of blades 155 shouldapproximately reach the bony interface between the articular cartilage(which is to be harvested) and the host bone (which is not intended tobe harvested). Then inner core 110 is rotated so that blades 155 excisethe tissue biopsy from the donor site and store the tissue biopsy withinlumen 125 of outer tube 105 (e.g., in the hollow receiving spaces 170formed between the blades 155). Preferably such tissue harvesting isconducted under direct visualization using an endoscope, with thetransparent distal end of outer tube 105 allowing the surgeon to observethe harvested tissue being stored within outer tube 105. At this pointmulti-blade cartilage biopsy tool 100 is withdrawn from the donor site,and then the harvested tissue biopsy (i.e., articular cartilage) iswithdrawn from multi-blade cartilage biopsy tool 100 for transportationto a processing laboratory where the autologous graft is created fromthe harvested tissue biopsy.

Multi-blade cartilage biopsy tool 100 preferably harvests the tissuebiopsy while the joint is being irrigated with fluid (e.g., saline),although such harvesting may also be effected in the absence ofirrigation.

(ii) Suction Curette Biopsy Tool 200 for Harvesting a Tissue Biopsy

Suction curette biopsy tool 200 is shown in detail in FIGS. 14-18.Suction curette biopsy tool 200 generally comprises a hollow tube 205having an angled distal end 210 adapted to harvest tissue, a proximalend 215 adapted for connection to a source of suction, and a lumen 217extending therebetween. In one preferred form of the present invention,hollow tube 205 comprises three separate elements which are integratedtogether so as to form the composite hollow tube 205: a distal tube 220,an intermediate tube 225 and a proximal tube 230, with the three tubesbeing connected to one another so as to provide a substantially rigidstructure having the continuous lumen 217 extending therethrough. Angleddistal end 210 includes sharpened edges 235 about some or all of itsperimeter so as to allow the angled distal end to mechanically separatethe desired tissue biopsy from its surrounding bone at the donor site. Aside opening 240 extends through the side wall of the tool (e.g.,through intermediate tube 225) and connects to continuous lumen 217extending through hollow tube 205, whereby to allow the user to controlthe magnitude of the suction applied at the distal end of the tool,e.g., by selectively blocking side opening 240 with a thumb or finger,different levels of suction can be applied to the distal end of thetool. By way of example but not limitation, by completely blocking offside opening 240 with a thumb or finger, substantially full suction canbe applied to the distal end of the tool.

In use, proximal end 215 of suction curette biopsy tool 200 is connectedto a source of suction and, with side opening 240 uncovered so thatlittle or no suction is applied to distal end 210 of the tool, thedistal end of suction curette biopsy tool 200 is arthroscopicallyadvanced to a donor site at a non-critical section of the joint. Thendistal end 210 of the suction curette biopsy tool is brought intoengagement with the donor site, and the sharpened edges 235 at thedistal end of the tool are used to mechanically excise the desiredtissue biopsy (i.e., articular cartilage) from the surrounding hostbone. Then side opening 240 is blocked (e.g., by the thumb of the user)so that suction is transmitted to the distal end of the tool. As aresult, the tissue biopsy excised by sharpened edges 235 is pulled (bysuction) against the distal end of the tool. Preferably the size of theopening 210 at the distal end of the tool is coordinated with the levelof suction applied to the proximal end of the tool so as to apply alevel of suction to the tissue biopsy which is adequate to hold theexcised tissue biopsy against the tool without damaging the tissuebiopsy or drawing the tissue biopsy too far into the lumen 217 of thetool. Then, with suction being maintained at the distal end of the tool,suction curette biopsy tool 200 is withdrawn from the donor site.Thereafter, the tissue biopsy is released from the suction curettebiopsy tool (e.g., by terminating the suction, and/or by replacing thesuction with positive fluid pressure) and transported to a processinglaboratory where the autologous graft is created from the harvestedtissue biopsy.

Suction curette biopsy tool 200 preferably harvests the tissue biopsywhile the joint is being irrigated with fluid (e.g., saline), althoughsuch harvesting may also be effected in the absence of irrigation.

2. Novel Arthroscopic Instrumentation for Sizing and Seating anAutologous Graft at an Implant Site

The present invention also comprises the provision and use of new andimproved arthroscopic instrumentation for sizing and seating anautologous graft at an implant site.

In one preferred form of the invention, two arthroscopic instruments areprovided to facilitate sizing and/or seating an autologous graft at animplant site: an arthroscopic tape measurer tool 300 (FIGS. 19-23) andan arthroscopic applicator tool and measuring template 400 (FIGS.24-31).

(i) Arthroscopic Tape Measurer Tool 300

Arthroscopic tape measurer tool 300 is shown in detail in FIGS. 19-23.Arthroscopic tape measurer tool 300 generally comprises a hollow tube305 connected to a handle 310. Hollow tube 305 has a lumen 312 extendingtherethrough. The distal end 315 of hollow tube 305 is preferably angledrelative to the longitudinal axis of the remainder of the hollow tube. Atape ribbon 320 is movably disposed within lumen 312 of hollow tube 305and has size markings 325 disposed on at least its distal end. Theproximal end of tape ribbon 320 is connected to a slide button 330 whichis movably mounted to handle 310. It should be appreciated that, as aresult of this construction, a user can selectively project the distalend of tape ribbon 320 out of the distal end of hollow tube 305 byappropriate movement of slide button 330 relative to handle 310.

In use, the distal end of tape ribbon 320 is initially withdrawn intohollow tube 305 (e.g., by appropriate movement of slide button 330relative to handle 310), and then the distal end of arthroscopic tapemeasurer tool 300 is arthroscopically advanced into a joint cavity sothat the distal end of the tool is located adjacent to a defect site.Next, tape ribbon 320 is advanced out the distal end of the tool (e.g.,by movement of slide button 330 relative to handle 310) and then taperibbon 320 is used to measure the size of a cartilage defect which is tobe restored with an autologous graft. Measurements may be determinedusing the markings 325 disposed on the distal end of the tape ribbonand/or by using corresponding calibrated measurements 335 formed onhandle 310 (which match the markings 325 on the distal end of the taperibbon). In addition, if desired, the proximal end of measuring tape 320could extend out of the proximal end of handle 310 and includecorresponding calibrated measurements on the proximal end of themeasuring tape (which would correspond to the markings formed on thedistal end of the tape ribbon and to the markings formed on the handle).The cartilage defect size information determined using tape ribbon 320is recorded. Then the distal end of tape ribbon 320 is retracted backinto hollow tube 305 (e.g., by appropriate movement of slide button 330relative to handle 310), and arthroscopic tape measure tool 300 iswithdrawn from the implant site. The measurements which were made of thecartilage defect using arthroscopic tape measurer 300 may then be usedto size the autologous graft for proper seating at the implant site.

Arthroscopic tape measurer 300 may be used to measure the size of thecartilage defect while the joint is being irrigated with fluid (e.g.,saline), or it may be used to measure the size of a defect in theabsence of irrigation.

(ii) Arthroscopic Applicator Tool and Measuring Template 400

Arthroscopic applicator tool and measuring template 400 is shown inFIGS. 24-31. Arthroscopic applicator tool and measuring template 400generally comprises an outer tube 405 and an inner rod 410. Outer tube405 comprises a distal end 406, a proximal end 407 and a lumen 408extending therebetween. Outer tube 405 also includes a slot 415intermediate its length. In one preferred form of the present invention,at least the distal end of outer tube 405 is transparent. Inner rod 410comprises a distal end 411 and a proximal end 412. Inner rod 410 ismovably disposed within outer tube 405 and comprises a measuringtemplate 420 disposed at its distal end 411 and a shaft knob 425intermediate the length of inner rod 410. Shaft knob 425 extends throughslot 415 in outer tube 405 so that the disposition of inner rod 410vis-à-vis outer tube 405 can be manipulated via shaft knob 425.

Measuring template 420 is preferably constructed out of a clear materialand preferably has a measuring grid 430 printed thereon. Measuringtemplate 420 is formed out of material which is (i) capable of foldingalong its longitudinal axis (FIGS. 27 and 28) so that the measuringtemplate can be received within the interior of hollow tube 405, and(ii) provides minimal or no adhesion with the autologous graft. As aresult of this construction, the user can use shaft knob 425 toselectively project measuring template 420 out of the distal end ofhollow tube 405 or withdraw measuring template 420 back within thedistal end of the hollow tube. Preferably, measuring template 420 has atapered configuration adjacent to its proximal end (FIG. 24), andpreferably the entrance to the distal end of hollow tube 405 has atapered configuration (not shown in the drawings), such that retractionof the measuring template into the hollow tube causes the measuringtemplate to automatically self-fold into a tubular configuration as themeasuring template is withdrawn into the hollow tube. It will beappreciated that where the distal end of outer tube 405 is transparent,the folded measuring template 420 will be visible to the user when themeasuring template has been withdrawn into outer tube 105. See FIGS. 27and 28.

In use, the distal end of measuring template 420 is first withdrawn intohollow tube 405, and then the distal end of arthroscopic applicator tooland measuring template 400 is arthroscopically advanced to an implantsite. Next, measuring template 420 is advanced out of the distal end ofthe tool and used (e.g., under endoscopic visualization) to measure thesize of the defect which is to be restored with the autologous graft.These measurements may be recorded by hand, or by camera, or byarthroscopically marking the measuring template in situ (e.g., with amarking pen). Then measuring template 420 is withdrawn back into theinterior of hollow tube 405, and the tool is withdrawn from the patient.

Next, the measuring template 420 is reduced in size to match therecorded size of the cartilage defect. This may be done on a “backtable” by projecting measuring template 420 out of the distal end ofhollow tube 405 and then cutting the measuring template down to size,e.g., with scissors. If desired, measuring template 420 may be returnedto the site of the defect to confirm fit. With the sizing of measuringtemplate 420 confirmed, measuring template 420 may then be used to sizethe autologous graft for proper seating at the implant site. By way ofexample but not limitation, this may be done by placing the autologousgraft on the sized measuring template and then trimming off any graftoverhang.

Once the autologous graft has been properly sized, the autologous graftis positioned on measuring template 420 (if it is not already onmeasuring template 420), and then the measuring template is withdrawninto the interior of hollow tube 405. This action causes the autologousgraft, which is seated on the measuring template, to be folded alongwith the measuring template and carried into the hollow tube along withthe measuring template. It will be appreciated that where the distal endof outer tube 405 is transparent, and where measuring template 420 istransparent, the autologous graft will be visible to the user when theautologous graft has been withdrawn into outer tube 405. Then the distalend of the tool is arthroscopically advanced to the implant site. Next,the measuring template (carrying the autologous graft with it) isadvanced out the distal end of the tool and positioned adjacent to theimplant site. Then the autologous graft is slid off the measuringtemplate and onto the implant site, whereupon the autologous graft willeither naturally adhere to the bone bed due to the natural adhesionbetween the bone bed and the autologous graft and/or an adhesive or amechanical device (e.g., a dart) may be used to secure the autologousgraft to the bone. Measuring template 420 is then withdrawn back intothe interior of hollow tube 405, and finally the tool is withdrawn fromthe implant site.

In connection with the foregoing, it will be appreciated thatarthroscopic applicator tool and measuring template 400 is intended tofold the autologous graft into the interior of the tool for transport toan interior surgical site. To this end, some autologous grafts may bemore flexible than others. Therefore, with less flexible autologousgrafts, the graft may be formed thinner so as to retain as muchflexibility as possible—in this case, a graft of greater height may beformed in situ by sequentially delivering two or more individual grafts,with the individual grafts stacking one on top of another at thesurgical site so as to form a final graft of the desired thickness. Ifdesired, cement may be applied between successive layers of the graft tohold the layers in position relative to one another, and relative to thehost bone.

Arthroscopic applicator tool and measuring template 400 may be used tomeasure the size of the cartilage defect while the joint is beingirrigated with fluid (e.g., saline), or it may be used to measure thesize of the defect in the absence of irrigation.

Arthroscopic applicator tool and measuring template 400 is preferablyused to deliver the autologous graft to the implant site afterirrigation has ceased.

3. Exemplary Procedure

FIGS. 32-44 show selected steps from an exemplary procedure forharvesting a tissue biopsy from a non-critical section of a joint, andsizing and seating an autologous graft at the implant site, using thenovel instrumentation of the present invention.

More particularly, FIG. 32 shows a tissue biopsy being taken from anon-critical section of a joint using the multi-blade cartilage biopsytool 100. FIGS. 33 and 34 show arthroscopic tape measurer tool 300measuring a defect site. FIG. 35 shows arthroscopic applicator tool andmeasuring template 400 having its measuring template 420 cut to size andthe sized measuring template having its dimensions confirmedarthroscopically. FIGS. 36-38 show the autologous graft being sized tofit the sized measuring template 420 and being stored inside outer tube405 of the arthroscopic applicator tool and measuring template 400.FIGS. 39-42 show arthroscopic applicator tool and measuring template 400delivering the autologous graft to the implant site. And FIGS. 43 and 44show the autologous graft having its position confirmed at the implantsite.

Modifications

It should also be understood that many additional changes in thedetails, materials, steps and arrangements of parts, which have beenherein described and illustrated in order to explain the nature of thepresent invention, may be made by those skilled in the art while stillremaining within the principles and scope of the invention.

1.-14. (canceled)
 15. An arthroscopic tape measurer tool comprising: ahollow tube having a distal end, a proximal end, and a lumen extendingbetween the distal end and the proximal end; a tape ribbon movablydisposed within the lumen of the hollow tube, the tape ribbon havinglength markings thereon; and movement means for moving the tape ribbonrelative to the hollow tube.
 16. An arthroscopic tape measurer toolaccording to claim 15 wherein the movement means comprise a slide buttonconnected to the tape ribbon, and wherein the slide button is movablymounted to the hollow tube, such that movement of the slide buttonrelative to the hollow tube causes movement of the tape ribbon relativeto the hollow tube.
 17. An arthroscopic tape measurer tool according toclaim 15 wherein the distal end of the hollow tube is angled relative tothe remainder of the hollow tube.
 18. A method for arthroscopicallymeasuring a graft site, the method comprising: providing an arthroscopictape measurer tool comprising: a hollow tube having a distal end, aproximal end, and a lumen extending between the distal end and theproximal end; a tape ribbon movably disposed within the lumen of thehollow tube, the tape ribbon having length markings thereon; andmovement means for moving the tape ribbon relative to the hollow tube;manipulating the movement means so that the tape ribbon is withdrawninto the interior of the hollow tube; advancing the distal end of thehollow tube so that it resides adjacent to a graft site; manipulatingthe movement means so that the tape ribbon is extended out of the distalend of the hollow tube; and using the length markings formed on the taperibbon to measure the graft site.
 19. An arthroscopic applicator tooland measuring template comprising: an outer tube having a distal end, aproximal end, and a lumen extending between the distal end and theproximal end; and an inner rod comprising a shaft having a distal endand a proximal end, and a measuring template mounted to the distal endof the shaft; the inner rod being movably mounted within the lumen ofthe outer tube such that the distal end of the inner rod can project outthe distal end of the outer tube or be withdrawn into the lumen of theouter tube; and the measuring template being foldable along itslongitudinal axis so that the measuring template can be received withinthe interior of the outer tube.
 20. An arthroscopic applicator tool andmeasuring template according to claim 19 wherein the measuring templatehas a tapered configuration adjacent to its proximal end so thatretraction of the measuring template into the hollow tube causes themeasuring template to automatically self-fold into a tubularconfiguration as the measuring template is withdrawn into the hollowtube.
 21. An arthroscopic applicator tool and measuring templateaccording to claim 19 wherein the measuring template is formed out of amaterial which provides minimal adhesion with an autologous graft. 22.An arthroscopic applicator tool and measuring template according toclaim 19 wherein the measuring template is transparent.
 23. Anarthroscopic applicator tool and measuring template according to claim19 wherein the measuring template comprises measurement markings.
 24. Anarthroscopic applicator tool and measuring template according to claim19 wherein the measuring template is formed out of material which iscuttable.
 25. An arthroscopic applicator tool and measuring templateaccording to claim 19 wherein at least the distal end of the outer tubeis transparent.
 26. (canceled)
 27. (canceled)